Catheter ablation of atrial fibrillation

Abstract

Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice, leading to more hospital admissions than any other arrhythmia. AF is commonly associated with structural heart disease such as valvular disease, coronary artery disease or cardiomyopathies. As with any other procedure in clinical medicine, potential risks and benefits need to be considered in deciding what to recommend for a particular patient. Balloon-based ablation systems are an attractive method of performing pulmonary vein isolation. Cryoballoon ablation appears to be the most completely tested. In 2011 ACCF/AHA/HRS Focused Update on the management of patients with AF state that catheter ablation performed in experienced centers is useful in maintaining sinus rhythm in selected patients with significantly symptomatic, paroxysmal AF who have failed treatment with an anti-arrhythmic drug and have normal or mildly dilated left atria, normal or mildly reduced LV function, and no severe pulmonary disease (Level of evidence: A; class of recommendation changed from IIa to I and level of evidence changed from C to A). Furthermore, the authors have added a new recommendation that state Catheter ablation is reasonable for treating symptomatic persistent AF (class IIa, level of evidence: A).